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COVID-19 booster doses at a vaccine clinic at the Northgate Mall in San Rafael, Calif. on Wednesday, Sept. 29, 2021. (Sherry LaVars/Marin Independent Journal)
COVID-19 booster doses at a vaccine clinic at the Northgate Mall in San Rafael, Calif. on Wednesday, Sept. 29, 2021. (Sherry LaVars/Marin Independent Journal)

Marin County is continuing to see widespread transmission of COVID-19 as health officials ramp up efforts to deal with what promises to become a new pandemic: monkeypox.

“Right now we are in the longest prolonged period of high transmission rates as a county since the start of the pandemic,” Dr. Matt Willis, the Marin County public health officer told Marin supervisors Tuesday, regarding COVID-19.

“We’re now in a high plateau period that is being fueled by the BA.5 subvariant of omicron,” he said. “We’ve had approximately 80 to 100 new cases per day for two months at least.”

Regarding monkeypox, a DNA virus that, until recently, was rarely seen outside the tropical rainforest areas of central and west Africa, Willis said he expects it to be formally designated a pandemic soon.

“I would call it a pandemic,” the health officer said, “because it meets the criteria now. It’s an epidemic in most nations.”

So far, two monkeypox cases have been confirmed in Marin and a third is suspected.

Willis said the estimate of COVID-19 cases, based on both lab tests and home tests reported to the county, is almost certainly an undercount.

“The way we know that is by looking at our wastewater,” he said.

The amount of virus in Marin wastewater is similar to the amount in January, when case counts were three times as high. Now more testing is done at home, which is much less reliably reported to the county.

The increased number of cases is resulting chiefly because the BA.5 variant is more transmissible and can infect people who have been vaccinated or contracted the virus previously. BA.5 currently accounts for between 90% and 100% of Marin’s COVID-19 cases.

Supervisor Damon Connolly said the high rate of transmission coincides with reports from his constituents.

“From what I’m hearing anecdotally in the community is a lot of people are getting it,” Connolly said. “And they’re showing significant symptoms. It’s knocking folks on their proverbial rear ends.”

Willis said the good news is that the number of Marin residents being hospitalized due to COVID-19 has not risen in tandem with the increased transmission.

“Our rates of hospitalization due to COVID have been relatively stable at around 10 people per day for about two months,” he said.

Willis said a variety of factors have resulted in Marin’s COVID-19 death rate falling dramatically since the early days of the pandemic. Seventy percent of Marin’s total 256 COVID-19 deaths occurred in the first year of the pandemic before vaccines were widely available.

In addition to vaccines preventing infection, home testing has allowed for earlier diagnosis so that inpatient and outpatient treatments, such as Paxlovid, can be administered.

“We’re seeing about one death per week now,” Willis said.

The health officer said that in 2020 there was a one in 10 chance that if a Marin resident over the age of 65 contracted COVID-19 that they would die. Today, there is only a 1% chance of a Marin resident over the age of 65 dying if they catch the disease.

The public health officer said Paxlovid reduces the chance of hospitalization by 89%.

Connolly, however, said he had heard from people who said they had trouble getting COVID-19 treatment through their health care providers. Supervisor Dennis Rodoni asked how people who lack a regular health care provider can access the drug.

Willis said he would like to know which if any health care providers are failing to provide treatment. He said low-income Marin residents can get Paxlovid at any of Marin’s federally qualified health centers, such as the Marin Community Clinics or the Marin City Health and Wellness Center.

If that fails, Willis said people can go to one of the county’s Optum Serve/LHI testing sites.

Marin public health is recommending that residents age 50 and older, as well as those with conditions that place them at heightened risk, get a second vaccine booster shot. And while public health has no plans to reimpose mask mandates, the department is recommending that residents don masks when mixing with large numbers of people indoors.

“A high-quality mask does protect you from being infected,” Willis said, “so carry a mask with you and use your judgment.”

As for monkeypox, Willis said public health is seeking to get more vaccine from the state and working with the Spahr Center to get the word out to the community most at risk: men who have sex with men.

The public health officer said so far the county has received 150 doses of the monkeypox vaccine, “which is not nearly enough.”

Public health has distributed most of what it has received to local health care providers; Kaiser Permanente was given 60 doses. The county has requested 1,000 additional doses.

“We organized a letter that we’re sending this week to the California Department of Public Health signed by a number of key Marin elected officials that back up that ask,” said Adrian Shanker, executive director of the Spahr Center, following Tuesday’s meeting.

“We know that everyone is working with a vaccine shortage but we believe that Marin County deserves a fair allocation of the vaccine,” Shanker said.

Willis said that monkeypox is mainly transmitted through intimate skin-to-skin contact. Symptoms include a rash with lesions, usually in the genital area, as well as fever, headaches, muscle aches and swollen lymph nodes.

Both Willis and Shanker recommend that anyone experiencing symptoms get tested and refrain from sexual contact. People who contract monkeypox can remain infectious for up to a month.

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